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Query: UMLS:C0019693 (HIV)
 170,526 document(s) hit in 31,850,051 MEDLINE articles (0.00 seconds)

Involvement of the central nervous system (CNS) is common in patients with advanced disease due to human immunodeficiency virus (HIV). Symptoms range from lethargy and apathy to coma, incoordination and ataxia to hemiparesis, loss of memory to severe dementia, and focal to major motor seizures. Involvement may be closely associated with HIV infection per se, as in the AIDS dementia complex, but is frequently caused by opportunistic pathogens such as Toxoplasma gondii and Cryptococcus neoformans or malignancies such as primary lymphoma of the CNS. The clinical presentations of attendant and direct CNS involvement are remarkably non-specific and overlapping, yet a correct diagnosis is critical to successful intervention. Toxoplasmic encephalitis is one of the most common and most treatable causes of AIDS-associated pathology of the CNS. A great deal has been learned in the last 10 years about its unique presentation in the HIV-infected patient with advanced disease. Drs. Benjamin J. Luft of the State University of New York at Stony Brook and Jack S. Remington of the Stanford University School of Medicine and Palo Alto Medical Foundation's Research Institute have studied T. gondii for many years and are two of the leading experts in the field. This commentary comprises an update of their initial review (J Infect Dis 1988;157:1-6) and a presentation of the current approaches to diagnosing and managing toxoplasmic encephalitis in HIV-infected patients.
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PMID:Toxoplasmic encephalitis in AIDS. 152 Jul 57

During a three-month period in 1989, 820 pregnant women attending the antenatal clinic of the Aarhus University Hospital, Denmark, were offered a HIV-antibody test and asked to fill out an anonymous questionnaire about attitudes to HIV-antibody testing; 779 (95.0%) agreed to do so. One hundred and fifty-six women (20.0% of the participants) had been tested on a previous occasion, and 629 (80.7%) accepted the present offer to be tested. The most prevalent reasons to decline testing were indifference to the epidemic (45.3% of those declining), refusal of (further) blood testing (34.7%) and fear of being infected (16.7%). Women who consented to be tested most often expressed fear of being infected (21.8%). Fear of registration worried less than 5% of study group members; only 1% declined to be tested because of such worry. The pattern of worries expressed by the pregnant women is interpreted as one of anxiety and, in part at least, perplexity as concerns how to take rational consequences of public messages about the HIV epidemic. It is suggested that future surveillance be based primarily on voluntary testing and, whenever needed and possible, supplied with anonymous unlinked testing of existing blood samples from groups and persons declining to be tested. Such surveillance strategies should be supported in individual patient contacts and public health educational campaigns underscoring the risk of heterosexual transmission of HIV and the need for repeated HIV-antibody testing of selected groups and individuals.
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PMID:Anxiety in voluntary HIV-antibody testing in pregnancy and its implications for preventive strategies. 186 58

This is the 1st study of adolescents' attitudes toward taking precautions to prevent contracting HIV/AIDS, taken from a survey of 370 Australian secondary school students aged 15-16, based on theory of Erikson and Marcia. The 4 stages of Marcia, of Erikson's developmental stage of identity development, are 1) identity diffusion, characterized by apathy; 2) foreclosure, with preliminary choices taken from parents, peers or fashions; 3) moratorium, where teens are searching for direction, but need more clarification, and may be confused on in conflict over attitudes, values and beliefs, and 4) identity achievement, with choice and commitment. A questionnaire of 19 items was administered to teens with parental permission. While 83% knew that condoms may prevent spread of HIV, 38% had never thought about using them. 30-70% answered questions as though they were in the identity diffusion stage. 5% stated they did not intend to use condoms, while 63% said they did. Status-linked questions were subjected to discriminant function analysis. Those intending to use condoms tended to be cautious, responsible, good communicators, female, more knowledgeable, with positive attitudes toward sexual planning, and fewer negative attitudes toward condoms. The undecided group scored high on moratorium items, suggesting that they would be easier targets for sex education, peer group discussions and values clarification. This study suggested that adolescents cannot be considered identical, even with 1 sex, and that changes in attitudes can be approached in steps.
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PMID:Adolescents' attitudes towards AIDS precautions and intention to use condoms. 228 79

The acquired immunodeficiency syndrome (AIDS) dementia complex is a frequent and devastating complication of infection with human immunodeficiency virus-type 1 (HIV-1). Features of the AIDS dementia complex include decreased memory, the inability to concentrate, apathy, and psychomotor retardation. Typical neuropathologic findings include gliosis, focal necrosis of neurons, perivascular inflammation, formation of microglial nodules, multinucleated giant cells, and demyelination. That HIV-1 is the direct cause of this neurologic syndrome is strongly supported by the available evidence. In addition, several studies have identified the monocyte-macrophage as the predominant cell type in the brain infected with HIV-1. However, the mechanisms by which the infected monocytes-macrophages mediate neurologic dysfunction and destruction have not been elucidated.
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PMID:The acquired immunodeficiency syndrome (AIDS) dementia complex. 254 29

Intravenous drug abusers in a methadone program in Minnesota were offered HIV-antibody screening to determine the degree of interest in screening and extent of infection. Thirty-nine (85 percent) were willing to be tested. Only seven refused. All patients were aware of acquired immunodeficiency syndrome (AIDS) and their high risk of exposure to the AIDS virus through sharing of injection paraphernalia. None reported exposure to additional risk factors, such as homosexual or bisexual activity or having received a blood transfusion. Of the patients tested, none was positive for HIV antibodies. The high degree of patient interest in screening was unanticipated as was the lack of positive laboratory findings for HIV antibodies. Factors associated with acceptance of testing included patient awareness of high seroprevalence rates, indifference to potential negative social consequences of positive HIV-antibody status, and the voluntary nature of the testing. These findings raise a cautious sense of optimism about HIV-antibody screening for similar risk groups.
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PMID:The voluntary acceptance of HIV-antibody screening by intravenous drug users. 311 49

The paper describes the psychiatric status on the basis of 76 patients with acquired immune deficiency syndrome. There is considerable difference between the different stages of the disease. The disorders are divided into groups following the German and French psychopathological tradition, where the incidence is dependent on the underlying complaint. 50% of the patients suffered from chronic psychoorganic disorders (34% organic personality disorders, 16% dementia). 9% suffered from an acute psychosis caused by complications and founded on substantial physical illness. 3 patients showed symptoms of a (under given circumstances) hitherto unknown endoform psychosis. In 9% of the patients, psychoreactive disturbances (anxiety and reactive depression) were observed. Two infants had congenital development deficiencies. 25% of the patients were without any psychopathology. Patients showing organic personality disorders mostly resemble each other to such a degree as to form a separate group. We suggest to name this group according to the most prominent psychopathology as "AIDS-lethargy". This status is characterised by a specific apathy, tiredness and indolence of the patients combined with the lack of emotional participation related to their own destiny. AIDS-lethargy is the first manifestation in appearance of the HIV infection of the brain itself. Another sequel of the brain infection is AIDS dementia which can be classified as "subcortical dementia" and differs from the more current forms of dementia clinically. Affected are mainly neuropsychologic functions like arousal, attention, mood and motivation, whereas the hallmarks of cortical involvement-aphasia, agnosia and apraxia-are not present. Supplementary findings (EEG, CCT, CSF): The group of patients with chronic psychoorganic disorders differs significantly from the group with psychoreactive disorders and normals. Pathological EEG and CCT are more frequent in psychoorganic disorders. CSF-test-including the intrathecally synthesized antibodies against HIV-does not show traceable variation in either group. There are four problems which may be combined in a given acute psychopathological HIV-syndrome: 1. Being member of a risk group with its reactive, psychosocial and personality problems. 2. Individual mental and emotional reaction to the fact of infection 3. Chronic psychoorganic disturbances. 4. Acute organic psychoses as a result of complications and other physical illness.
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PMID:[Psychopathologic pictures in HIV infection: AIDS lethargy and AIDS dementia]. 340 94

Between June 1986 and October 1992, disseminated toxoplasmosis was diagnosed in 16 AIDS patients. 13 cases were diagnosed at autopsy where multiple organ involvement was documented in all 13. Three patients were diagnosed intra vitam. All 3 survived with appropriate treatment. Clinical features indicative of disseminated toxoplasmosis were: fever of unknown origin between 39 degrees and 40 degrees C in 16 cases, clinical signs suggestive of sepsis or septic shock in 15, with progression to multiorgan failure in 10, disseminated intravascular coagulopathy in 6, confusion, disorientation or apathy in 13 and lack of a systemic pneumocystis carinii prophylaxis in all 16. Typical laboratory markers were: CD4 cell counts below 100 x 10(6)/l in 16 cases, elevation of serum lactic dehydrogenase in 16 and creatine phosphokinase (in 4/6), normal or only slightly elevated C-reactive protein (in 9/11), positive Toxoplasma gondii IgG antibodies in 15/16 and negative IgM antibodies in all 16. Lesions indicative of cerebral toxoplasmosis were visualized on cranial computerized tomography in only 3/10 evaluated patients. In patients with advanced HIV infection presenting with a systemic illness, including the clinical and laboratory features described above, systemic Toxoplasma gondii infection must be included in the differential diagnosis. In these patients, specific and if warranted, invasive diagnostic procedures followed by early vigorous therapeutic intervention should be considered.
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PMID:Disseminated toxoplasmosis in AIDS patients--report of 16 cases. 778 18

Human Immunodeficiency Virus (HIV)-encephalopathy (formerly AIDS Dementia Complex, or ADC) is characterized by global impairment of intellectual and cognitive functions, personality and behavioral disturbances, decreased memory, inability to concentrate, and apathy. Its motor dysfunction is manifested by impaired speech, gait, and coordination, and by psychomotor retardation. Several scientific reports indicate that ADC may be the earliest, and, at times, the only evidence of human immunodeficiency virus infection, and may present a diagnostic challenge, particularly in the aviation context. Several aviation medicine specialists have pointed out the safety questions raised by this condition when it presents in otherwise asymptomatic individuals. Since October 1985, U.S. military pilots have been tested for the presence of HIV antibody and grounded if found positive. In May 1991, the Executive Council of the Aerospace Medical Association approved a position statement that supports testing of pilots for infection by HIV, and maintains that "individuals confirmed to be infected should be found medically disqualified for flying duties." While bureaucrats delay in resolving HIV mandatory screening, HIV-encephalopathy may be precipitously brought to light, with symptoms involving ocular motor disorders such as dissociated nystagmus, gaze-evoked nystagmus, and impaired saccadic function and smooth pursuit, frequent signs of HIV cerebellar and pontomesencephalic dysfunction.
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PMID:HIV-encephalopathy: should we await a catastrophe before screening? 783 42

The in vitro antibacterial activity of zidovudine alone and in combination with ciprofloxacin was investigated. Zidovudine showed a good activity against Escherichia coli and Salmonella (MIC range 0.5-8 micrograms/ml and 1.5-62 micrograms/ml respectively) isolated from biological samples of HIV-infected patients. These strains proved to be extremely susceptible to ciprofloxacin alone. The interaction between zidovudine and ciprofloxacin ranged from additive activity to indifference. No antagonism was observed: the FIC index for every combination resulted < or = 1.5. The addition of AZT 1 mg/l (clinically achievable plasma concentration after therapeutic doses of 1200 mg/day) did not affect the bactericidal activity of ciprofloxacin; on the contrary, in some cases we observed an increase of bactericidal effect of the quinolone. These data have to be considered in patients with AIDS who can be treated concomitantly with zidovudine and ciprofloxacin.
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PMID:In vitro activity of zidovudine alone and in combination with ciprofloxacin against Salmonella and Escherichia coli. 836 19

HIV encephalopathy, which is probably primarily caused by human immunodeficiency virus, is the most common neurological disorder in HIV-infected patients and is more frequent than opportunistic diseases of the central nervous system. It is characterized most often by slowly progressing cognitive impairment, psychomotoric slowing and increasing apathy. The syndrome is found almost exclusively in the late stages of HIV infection; its frequency in patients with full-blown AIDS is estimated as being between 40 and 70%. Although numerous studies have demonstrated alterations in the electrophysiological parameters, cerebral perfusion and cerebrospinal fluid in many asymptomatic patients, there are no reliable parameters that can predict the risk of developing HIV encephalopathy. Also, there is no sufficient correlation between the extent of the frequent but mostly subtle neuropathological changes and the clinical degree of the severity of the encephalopathy. The mechanisms causing cerebral injury are poorly understood. Recent studies indicate that the indirect effects of HIV infection of the brain are the most important pathogenetic factors. In particular, certain viral proteins and cytokines produced by infected macrophages or activated microglia seem to induce neuronal dysfunction and finally loss of nerve cells.
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PMID:[HIV encephalopathy--clinical aspects, neuropathology and pathogenesis]. 845 Aug 99


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